London area worst in Ontario for hip, knee replacement waits

The London region, Southwestern Ontario’s medical capital, ranks worst in Ontario and near the bottom in Canada in timely access for patients to hip and knee replacement surgery, new national figures show.

But while the London area fares poorly in the latest snapshot of wait times for the life-changing surgery, the Chatham-Sarnia-Windsor area is doing much better.

The South West Local Health Integration Network (LHIN), the provincial agency that allocates health spending in much of Southwestern Ontario including London, is tied for 13th worst of the 71 health administration districts in Canada’s 10 provinces for the percentage of patients given hip replacement surgery within a 182-day target.

It ranks 14th from the bottom for the same in knee replacements, new data compiled by the Canadian Institute for Health Information (CIHI) shows.

A region in southern Saskatchewan ranks first in Canada in knee replacements, with all patients getting surgery within the target wait.

Three health agencies, two in Quebec and one in Labrador, tied for first in hip replacement wait times with 100 per cent each.

Provinces have considered the wait-time figures “a bit of a bellwether” since they started being reported in 2004, said Tracy Johnson, CIHI’s director of health system analysis.

“They are a flag or a signal,” she said. “It’s telling us that there are some challenges in the health systems in meeting the needs of the populations they have right now.”

Fixing the issues behind excessive wait times – patients can be left languishing in pain and unable to move or work – needs to be a priority for governments, said Dr. John Antoniou, president of the Canadian Orthopedic Association.

“Hip replacement and knee replacement surgeries are some of the best surgeries that medicine has to offer,” he said, adding the procedures are rivalled only by cataract surgery in how they can improve quality of life.

“It’s a life-changer,” said Antoniou.

The CIHI figures count the time from the day a patient and orthopedic specialist decide to go ahead with surgery to the day they go under the knife. The agency analyzed wait time data gathered by provincial health accountability agencies.

The percentage of patients getting joint replacement surgeries within the 182-day target in the South West LHIN rose slightly in 2018 from the year before, the first sign of improvement in four years.

Still, only 59 per cent of hip replacement patients and 57 per cent of knee replacement patients in the area received their surgery within the benchmark timeframe, far below the Ontario average of 84 per cent and 79 per cent, respectively.

And the South West LHIN rates have fallen significantly in recent years. In 2014, 78 per cent of hip replacement patients and 81 per cent of knee replacement patients in the area got their surgeries within 182 days.

Last year in the Erie St. Clair LHIN, which includes Sarnia, Chatham-Kent and Windsor, 85 per cent of its hip replacement patients and 79 per cent of knee replacement patients had their procedures within six months.

Many factors, including differences in patient demand for surgery and funding allocations for hospitals by the province, account for the disparities in wait times between regions, said John Harrington, president of the Ontario Orthopedic Association.

Hospitals in Ontario are given money from the province to perform a set number of hip and knee replacement surgeries each year, he said. If there are more patients than funded surgeries in a region, it creates wait lists.

The average cost of a total knee replacement including hospital care is $15,000. Hip replacements cost nearly $16,000.

In January, Strathroy Middlesex General Hospital had the longest average wait time for both types of surgeries in Ontario: 489 days from decision to procedure for knees, and 372 for hips.

It doesn’t have to be that way, Harrington said.

“I think it boils down to funding,” said Harrington, an orthopedic surgeon in Brampton. “I could absolutely do more joint replacement surgeries and so could all of my colleagues.”

In a statement, South West LHIN chief executive Renato Discenza said the agency – its coverage area has a higher proportion of adults older than 65 than the provincial average, she noted – has invested more than $2 million in one-time funding since 2017, paying for an extra 500 procedures.

It also soon will launch a centralized patient assessment and intake system to streamline the process from specialist consultation to surgery.

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